COVID‐19 may cause pneumonia, acute respiratory distress syndrome, cardiovascular alterations, and multiple organ failure, which have been ascribed to a cytokine storm, a systemic inflammatory response, and an attack by the immune system. Moreover, an oxidative stress imbalance has been demonstrated to occur in COVID‐19 patients. N‐ Acetyl‐L‐cysteine (NAC) is a precursor of reduced glutathione (GSH). Due to its tolerability, this pleiotropic drug has been proposed not only as a mucolytic agent, but also as a preventive/therapeutic agent in a variety of disorders involving GSH depletion and oxidative stress. At very high doses, NAC is also used as an antidote against paracetamol intoxication. Thiols block the angiotensin‐converting enzyme 2 thereby hampering penetration of SARS‐CoV‐2 into cells. Based on a broad range of antioxidant and anti‐inflammatory mechanisms, which are herein reviewed, the oral administration of NAC is likely to attenuate the risk of developing COVID‐19, as it was previously demonstrated for influenza and influenza‐like illnesses. Moreover, high‐dose intravenous NAC may be expected to play an adjuvant role in the treatment of severe COVID‐19 cases and in the control of its lethal complications, also including pulmonary and cardiovascular adverse events.

中文翻译：

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在 COVID-19 的预防和辅助治疗中使用 N-乙酰半胱氨酸的基本原理

COVID-19 可能导致肺炎、急性呼吸窘迫综合征、心血管改变和多器官衰竭，这些都归因于细胞因子风暴、全身炎症反应和免疫系统的攻击。此外，已证明 COVID-19 患者会出现氧化应激失衡。N-乙酰-L-半胱氨酸 (NAC) 是还原型谷胱甘肽 (GSH) 的前体。由于其耐受性，这种多效性药物不仅被提议用作粘液溶解剂，而且还被用作涉及 GSH 耗竭和氧化应激的各种疾病的预防/治疗剂。在非常高的剂量下，NAC 也可用作扑热息痛中毒的解毒剂。硫醇会阻断血管紧张素转换酶 2，从而阻碍 SARS-CoV-2 渗透到细胞中。基于本文综述的广泛的抗氧化和抗炎机制，NAC 的口服给药可能会降低发生 COVID-19 的风险，正如之前对流感和流感样疾病所证明的那样。此外，大剂量静脉注射 NAC 有望在治疗重症 COVID-19 病例和控制其致命并发症（包括肺部和心血管不良事件）中发挥辅助作用。